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Transcript

Good afternoon. It’s a pleasure to present our trial, a web-based stress management for newly diagnosed cancer patients. Diagnosis of cancer elicits high levels of distress which negatively affect physical and mental health. Furthermore, distress can lead to diminished treatment tolerance and compliance. From randomised controlled trials we know that cognitive behavioural therapies are effective in alleviating distress, however the majority of cancer patients lack psychological support due to both barriers on the patient’s side and lack of resources on the provider’s side.

That’s where the internet comes in – 70% of cancer patients use the internet primarily to seek information. From randomised controlled trials in non-cancer patients it seems that internet interventions, especially in the therapist-guided format, are as effective as face-to-face interventions in a number of psychological conditions including anxiety disorders and depression. We therefore designed a therapist-guided online stress management programme specifically for newly diagnosed cancer patients and aimed to assess feasibility and efficacy in a randomised controlled trial.

Patients who started their first line cancer treatment within the last three months were eligible. They were randomised in a one-to-one fashion to the intervention or to a control group stratified according to baseline distress. The intervention consisted of eight online modules with information, exercises and downloadable audio files. There was a weekly written feedback with our team of psychologists through an integrated chat function. The primary efficacy outcome was quality of life as measured with the FACIT-F questionnaire after the intervention at T2. During the follow-up period patients from the control arm also gained access to the STREAM programme.

129 patients with a median age of 52 years were randomised. The majority were women and 71% were diagnosed with breast cancer; other cancers included lymphoma, gynae and GI cancers. So let’s see what happened after the intervention and jump directly to the efficacy results.

In the figure in the centre you can see that quality of life improved markedly in the intervention group. Increase in total FACIT-F score was significantly higher in the intervention group than in the control group by a mean of 8.59 points which is statistically significant and clinically relevant. Let’s look at distress on the left here where we see a very similar picture. Decrease in distress was significantly larger in the intervention group than in the control group, however, changes in mood, here on the right, were not different between groups.

In conclusion, our online stress management programme was feasible with newly diagnosed cancer patients during active treatment. We were able to reach cancer patients via the internet. The majority of patients were women with breast cancer treated for localised disease. At baseline three in four patients were highly distressed so we reached a target population in need of support. Last but not least, the intervention worked; the therapist-guided online programme significantly improved quality of life and lowered distress. Thank you.